scholarly journals Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana

2015 ◽  
Vol 13 (1) ◽  
Author(s):  
Robert Kaba Alhassan ◽  
Edward Nketiah-Amponsah ◽  
James Akazili ◽  
Nicole Spieker ◽  
Daniel Kojo Arhinful ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Facilities ◽  
Primary Health ◽  
Private And Public ◽  
Primary Health Facilities

scholarly journals DRUG COST ANALYSIS ON NATIONAL HEALTH INSURANCE ERA IN HEALTH SUPPORT FACILITIES

2017 ◽  
Vol 10 (2) ◽  
pp. 119
Author(s):  
Satibi Satibi ◽  
Dewa Ayu Putu Satrya Dewi ◽  
Atika Dalili Akhmad ◽  
Novita Kaswindiarti ◽  
Dyah Ayu Puspandari
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
Drug Cost ◽  
National Health ◽  
Health Facilities ◽  
Drug Costs ◽  
Average Percentage ◽  
Primary Health

Objective: In national health insurance (JKN) era, pharmacy can play roles in the form of behind refer pharmacies, or networking pharmacy and clinic pharmacy pratama. Behind refer pharmacies drug cost can be claimed directly to BPJS, meanwhile for the other type of pharmacy have to negotiation first with the primary health care. Drug cost variations in the JKN era affect the profitability of the business pharmacies. This research aims to the drug percentage charges against capitation and variety of drug costs.Methods: This research is analytic observational cross-sectional. This research uses secondary data from a JKN prescription patient. This research was conducted on 6 affiliated pharmacies, 6 networking pharmacies, and 7 clinical pharmacy pratama in DIY. The sampling in this research is by purposive with 8.430 prescriptions. Data drug costs JKN era was analyzed by descriptive statistics and comparative test (Kruskal Wallis test).Results: The result showed that average percentage of drug costs for capitation fee in the networking pharmacy is 13.58% and primary health care is 15.91%. Pharmacy in JKN era has drug cost variations (p=0.000). Drug cost in JKN era depends on the pattern of play roles with the health facilities and BPJS. The average percentage of drug costs against capitation health facilities in networking pharmacy is lower than clinical pharmacy pratama.Conclusions: Drug costs in an era of JKN depending on the pattern of cooperation with health facilities pharmacies and BPJS. The average percentage of the cost of drugs to the pharmacy capitation health facilities in networking lower than clinic pharmacy pratama. Differences in drug costs JKN era influenced by the long days of drug administration, the number of prescription sheets, margin.Keywords: Drug cost analysis, National health insurance (JKN), Pharmacy, Primary health care, Capitation.

Quality Healthcare Service Assessment under Ghana’s National Health Insurance Scheme

2019 ◽  
Vol 54 (4) ◽  
pp. 569-587
Author(s):  
Michael Kodom ◽  
Adobea Yaa Owusu ◽  
Perpetual Nancy Baidoo Kodom
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Public Hospital ◽  
National Health Insurance Scheme ◽  
Quality Of Healthcare ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Private And Public

Ghana implemented the National Health Insurance Scheme (NHIS) in 2005 with the intention of providing residents with quality affordable healthcare. Over the past few years, concerns have been raised about the quality of healthcare clients receive. This study assesses the experiences of NHIS subscribers with the quality of care they receive under the scheme by both private and public hospitals. The results from the 56 interviews show that the majority of the subscribers were dissatisfied with the overall quality of healthcare they received in both private and public hospital because of the long waiting hours, the poor attitude of nurses and the demand for payment of additional money. Even though clients who visited the private hospital paid for all services, excluding consultation, their level of satisfaction with the quality of healthcare was relatively higher than those who visited the public hospital. The paper concludes that NHIS clients do not receive the quality of healthcare the scheme promised, and this has implications for premium renewals and health-seeking behaviour.

scholarly journals Facility Managers’ Perceptions of Support and Supervision of Ward Based Primary Health Care Outreach Teams in National Health Insurance Pilot Districts in KwaZulu-Natal, South Africa. A Qualitative Study

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1718
Author(s):  
Euphemia Mbali Mhlongo ◽  
Elizabeth Lutge
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Care Facility ◽  
Health Care Facility ◽  
Primary Health Care Facility ◽  
Primary Health ◽  
Kwazulu Natal

Introduction: Evidence from many countries suggests that provision of home and community-based health services, linked to care at fixed primary health care facilities, is critical to good health outcomes. In South Africa, the Ward-Based Primary Health Care Outreach Teams are well placed to provide these services. The teams report to a primary health care facility through their outreach team leader. The facility manager/operational manager provides guidance and support to the outreach team leader. Aim: The aim of the study was to explore and describe the perceptions of facility managers regarding support and supervision of ward-based outreach teams in the National Health Insurance pilot sites in Kwa Zulu-Natal. Setting: The study was carried out in three National Health Insurance pilot districts in KwaZulu- Natal. Methods: An exploratory qualitative design was used to interview 12 primary health care facility managers at a sub-district (municipal) level. The researchers conducted thematic analysis of data. Findings: Some gaps in the supervisory and managerial relationships between ward based primary health care outreach teams and primary health care facility managers were identified. High workload at clinics may undermine the capacity of PHC facility managers to support and supervise the teams. Field supervision seems to take place only rarely and for those teams living far away from the clinic, communication with the clinic manager may be difficult. The study further highlights issues around the training and preparation of the teams. Conclusions: Ward based primary health care outreach teams have a positive impact in preventive and promotive health in rural communities. Furthermore, these teams have also made impact in improving facility indicators. However, their work does not happen without challenges.

scholarly journals The bypassing of healthcare facilities among National Health Insurance Scheme enrollees in Ibadan, Nigeria

2020 ◽  
Author(s):  
Adetola O Oladimeji ◽  
David A Adewole ◽  
Folashayo Adeniji
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Facilities ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional Survey ◽  
Additional Time ◽  
Cross Sectional

Abstract Background Bypassing occurs when patients knowingly visit a health facility other than the one they live nearest to. In Ibadan, southwest Nigeria, the majority of enrollees in the National Health Insurance Scheme (NHIS) receive medical care in just 12% of the available NHIS-accredited facilities. Given that enrollees access healthcare services at highly subsidized rates under the scheme, this study aimed to determine the factors responsible for the observed distribution of enrollees across these health facilities. Methods The study was a descriptive cross-sectional survey conducted among NHIS enrollees receiving care at outpatient departments of five randomly selected accredited health facilities in Ibadan. A total of 311 NHIS enrollees were consecutively recruited and a semistructured, pretested, interviewer-administered questionnaire was used to elicit information from respondents. Descriptive and inferential statistics were used to present results at 5% level of significance. Distance traveled by patients from their residence to the facilities was measured using Google maps. Results The mean age of respondents was 37.1±16.1 y. There were 167 (53.7%) males and 224 (72.3%) were married. The bypassing rate was 174 (55.3%). More than a third of enrollees, 127 (41.0%), reported that their hospital choice was made based on physician referral, 130 (41.8%) based on personal choice, 26 (8.4%) based upon the recommendation of the Health Management Organization (HMO), while 27 (8.7%) were influenced by friends/family/colleagues. Bypassing was positively associated with educational status (X2 = 13.147, p=0.004). Respondents who bypassed expended additional time and money traveling to the farther away hospitals, 35.1 (±34.66) min and 389.51 (±545.21) naira per visit, respectively. Conclusion The level of bypassing among enrollees was fairly high. Enrollees should be properly guided regarding the need to access healthcare in facilities closer to them by their HMOs and physicians in the case of referrals. This will reduce bypassing and the cost of travel leading to better outcomes among enrollees.

scholarly journals Determinan Keputusan Pekerja Mandiri menjadi Peserta Jaminan Kesehatan Nasional

2020 ◽  
Vol 14 (1) ◽  
pp. 21
Author(s):  
Jumatra Laila ◽  
Asmaripa Ainy ◽  
Dian Safriantini
Keyword(s):  
Health Insurance ◽  
Family Support ◽  
National Health Insurance ◽  
National Health ◽  
Health Workers ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
P Value ◽  
Cluster Sampling ◽  
Cross Sectional

Background: National health insurance is mandatory for all Indonesians. In Ogan Ilir Regency, the lowest percentage (24,14%) of its participants in December 2016 was found in Indralaya Utara Sub-district, and self-employed participants in this sub-district were only 6,99%. This study aimed to analyze the determinants of the self-employed’s decision to become national health insurance participants in Indralaya Utara Sub-district. Method: This was a cross-sectional study. The population was self-employed in Indralaya Utara Sub-district. The sample was 108 respondents who were selected using cluster sampling and consecutive sampling techniques. Data analysis was conducted by univariate and bivariate with chi-square statistical test. Results: The results illustrated that 18,52% of respondents decided to become national health insurance participants. Variables with p-value<0,005 were: knowledge about national health insurance (p-value=0,011), trust (p-value=0.000), perception about national health insurance (p-value=0,000), attitude (p-value=0,000), income (p-value=0,002), family support (p-value=0,005). Variables with p-value≥0,005 were: education (p-value=0,234), perception about health facilities (p-value=0,162), distance to health facilities (p-value=0,355), health workers support (p-value=0,112). Conclusion:  In conclusion, percentage of self-employed who decided become national health insurance participants was still small. Associated factors to the decision of self-employed as participants were: knowledge about national health insurance, trust, perception about national health insurance, attitude, income and family support. It is suggested that the Social Security Administrative Body for Health should routinely conduct socialization on national health insurance to improve the percentage of its participation for self-employed and the benefits of national health insurance could be felt by the entire community.

scholarly journals What alternative and innovative domestic methods of healthcare financing can be explored to fix the current claims reimbursement challenges by the National Health Insurance Scheme of Ghana? Perspectives of health managers

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Alexander Suuk Laar ◽  
Michael Asare ◽  
Philip Ayizem Dalinjong
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Healthcare Services ◽  
Health Facilities ◽  
Healthcare Financing ◽  
Insurance Scheme ◽  
Local Methods ◽  
Health Managers

Abstract Background Low-and-middle -income countries (LMICs), to achieve sustainable universal health coverage (UHC) governments are implementing local and sustainable methods of healthcare financing. However, in Ghana, there is limited evidence on these local methods for healthcare financing to inform policy. This study aimed at exploring health managers views on alternative domestic and sustainable methods of healthcare financing for UHC under the National Health Insurance Scheme (NHIS). Methods A qualitative study using in-depth interviews with 16 health facility managers were held. The health facilities and participants were selected using convenience and purposive sampling methods. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach. Results Health managers across all the health facilities mentioned delayed and erratic claims reimbursement to health facilities as the main challenge. Participants attributed the main reason to lack of funds by the National Health Insurance Authority (NHIA). They said the delayed and irregular payments has been a challenge to efficient delivery of quality healthcare to clients. That in some instances they have been compelled to demand cash or out-of-pocket payment from insured clients or insurance card bearers to be able to render needed healthcare services to them. Participants think that to ensure regular reimbursement of claims to the health facilities by the NHIA, the managers think alternative local sources of funding need to be explored to fill the funding gap. To put in place this, they suggested the need to start levying special taxes on natural resources such as crude oil and gas, gold, bauxite, cocoa, mobile money transfers, airtime and increasing the proportion of levies on the existing Value Added Tax (VAT). Conclusion The study provides important insights into potential innovative alternative domestic sources for raising additional funds to finance healthcare services in Ghana. Despite the potential of these sources, it is important for governments and health policy makers in Ghana and other LMICs who are working towards implementing innovative local methods using special levies on mobile communication services and natural resources to finance their UHC, to implement those that best suit their economies to ensure equity for better health.

scholarly journals Medicine management in districts and primary health care centres (PHC) in the national health insurance (JKN) programme

2021 ◽  
pp. 251-257
Author(s):  
Raharni ◽  
Rini Sasanti ◽  
Yuyun Yuniar
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Programme Implementation ◽  
District Health ◽  
Cross Sectional ◽  
Medicine Management ◽  
Primary Health

Objective: This study aimed to identify medicine management in district health offices and primary health care centres (PHCs) after the national health insurance (JKN) programme implementation. Methods: A cross-sectional study was carried out by collecting documents related to medication management and in-depth interviews with the head of the PHC officials and JKN medicine management officers at the PHC in four provinces of Indonesia. Results: The results showed no regional policies related to medicine management; all policies were based on central policies. Medicine management in districts follows the procurement planning suggested by PHCs, which relies on disease patterns. Medicine procurement at PHCs is done by e-purchasing using an e-catalog. Medicines above IDR 200 million are purchased through catalogs provided by the procurement service unit (ULP), and those under IDR 200 million are obtained through a direct appointment. Conclusion: The storage of medicine requires more space and air humidity controlling. The reporting and monitoring of medications e-logistic system are based on 20 indicators and have not been carried out regularly. It is necessary to improve reporting and monitoring systems.

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